Video laryngoscopy for endotracheal intubation of adult patients with suspected/ confirmed COVID-19. A systematic review and meta-analysis of randomized controlled trials

Ludwin, Kobi; Białka, Szymon; Czyżewski, Łukasz; Smereka, Jacek; Dąbrowski, Marek; Dąbrowska, Agata; Ładny, Jerzy Robert; Ruetzler, Kurt; Szarpak, Łukasz

doi:10.5603/demj.a2020.0023

Cited by 23 publications

(27 citation statements)

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“…Hence, it should be done with full personal protective equipment (PPE) [ 26 , 27 , 28 ], which remains challenging for clinicians. To support this, several studies showed the negative influence of PPE on rescuer comfort and ability to carry out CPR [ 29 , 30 , 31 ]. In addition, it could be hypothesized that the risk of viral transmission might discourage bystander CPR.…”

Section: Discussionmentioning

confidence: 99%

Impact of Coronavirus Disease 2019 on Out-of-Hospital Cardiac Arrest Survival Rate: A Systematic Review with Meta-Analysis

Borkowska

Jaguszewski

Koda

et al. 2021

JCM

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Out-of-hospital cardiac arrest (OHCA) is a challenge for medical staff, especially in the COVID-19 period. The COVID-19 disease caused by the SARS-CoV-2 coronavirus is highly infectious, thus requiring additional measures during cardiopulmonary resuscitation (CPR). Since CPR is a highly aerosol-generating procedure, it carries a substantial risk of viral transmission. We hypothesized that patients with diagnosed or suspected COVID-19 might have worse outcomes following OHCA outcomes compared to non-COVID-19 patients. To raise awareness of this potential problem, we performed a systematic review and meta-analysis of studies that reported OHCA in the pandemic period, comparing COVID-19 suspected or diagnosed patients vs. COVID-19 not suspected or diagnosed group. The primary outcome was survival to hospital discharge (SHD). Secondary outcomes were the return of spontaneous circulation (ROSC), survival to hospital admission or survival with favorable neurological outcomes. Data including 4210 patients included in five studies were analyzed. SHD in COVID-19 and non-COVID-19 patients were 0.5% and 2.6%, respectively (odds ratio, OR = 0.25; 95% confidence interval, CI: 0.12, 0.53; p < 0.001). Bystander CPR rate was comparable in the COVID-19 vs. not COVID-19 group (OR = 0.88; 95% CI: 0.63, 1.22; p = 0.43). Shockable rhythms were observed in 5.7% in COVID-19 patients compared with 37.4% in the non-COVID-19 group (OR = 0.19; 95% CI: 0.04, 0.96; p = 0.04; I2 = 95%). ROSC in the COVID-19 and non-COVID-19 patients were 13.3% vs. 26.5%, respectively (OR = 0.67; 95% CI: 0.55, 0.81; p < 0.001). SHD with favorable neurological outcome was observed in 0% in COVID-19 vs. 3.1% in non-COVID-19 patients (OR = 1.35; 95% CI: 0.07, 26.19; p = 0.84). Our meta-analysis suggests that suspected or diagnosed COVID-19 reduces the SHD rate after OHCA, which seems to be due to the lower rate of shockable rhythms in COVID-19 patients, but not due to reluctance to bystander CPR. Future trials are needed to confirm these preliminary results and determine the optimal procedures to increase survival after OHCA in COVID-19 patients.

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Section: Discussionmentioning

confidence: 99%

Impact of Coronavirus Disease 2019 on Out-of-Hospital Cardiac Arrest Survival Rate: A Systematic Review with Meta-Analysis

Borkowska

Jaguszewski

Koda

et al. 2021

JCM

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“…Performing medical procedures when healthcare workers are wearing PPE-AGP may reduce the effectiveness of the procedures performed by extending the duration of these procedures as well as reducing the effectiveness of individual attempts to perform the procedure. This applies to both obtaining intravascular access [11], advanced airway management [12], as well as the effectiveness of chest compression [13]. Chen et al [14] indicated significant deterioration of CC performance in HCWs with the use of a level-C personal protective equipment, which may be a disadvantage for enhancing the survival of cardiac arrest.…”

Section: Discussionmentioning

confidence: 99%

Comparison of different chest compression positions for use while wearing CBRN-PPE: a randomized crossover simulation trial

Małysz¹,

Jaguszewski

Szarpak

et al. 2020

Disaster Emerg Med J

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INTRODUCTION: The prevailing COVID-19 pandemic forces paramedics to take medical rescue operations using personal protective equipment (PPE) for aerosol-generating procedures (AGP). The use of PPE-AGP may reduce the effectiveness of the procedures performed, including airway management, intravascular access, or chest compression. The goal of the current study was to compare the quality by which a chest compression during simulated COVID-19 resuscitation while wearing PPE-AGP. A secondary goal was to assess provider preferences with standard versus OHD chest compression methods while wearing PPE-AGP. MeThODS: This is a randomized cross-over single-blinded study involving 37 paramedics performing 2-min continuous chest compression using two methods: the standard chest compression (CC) method during which the rescuer takes a position to the side of the victim (STD) and over-the-head position (OHD). During cardiopulmonary resuscitation, study participants wore Class C PPE-AGP. Both the order of study participants and compression methods were random. The results were blinded before statistical analysis. The compression rate per minute (CPM), CC depth as well as full chest recoil were measured. The analysis was undertaken using STATISTICA (V13.3EN). ReSULTS: Mean chest compression depth using distinct CC methods varied and amounted to 42 ± 2mm for STD vs. 46 ± 4mm for OHD (p < 0.001). Chest compressions based on the OHD method were associated with a lower frequency of chest compressions (107 ± 7CPM) compared with STD (114.5 ± 8; p< 0.001). A higher percentage of full chest recoil was observed in the case of STD (42 ± 6%) than in the case of OHD (34 ± 10%). CONCLUSIONS: Based on the current simulation trial, it is impossible to clearly determine which method (STD vs. OHD) is more effective in resuscitation with PPE-AGP. Paramedics wearing PPE-AGP achieved better chest compression depth for OHD compared to the STD, however, OHD resuscitation causes a lower degree of full chest relaxation. A further well-designed clinical study looking at efficacy, safety, and outcomes is needed to confirm current results.

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“…This tool is widely used to assess the methodological quality of RCTs and consists of the following six items: random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, and selective outcome reporting. According to the previous trials [8] each bias was graded 'yes', 'no', or 'unclear', which reflected a high risk of bias, low risk of bias, and uncertain bias, respectively.…”

Section: Risk Of Bias Assessmentmentioning

confidence: 99%

Airtraq® versus Macintosh laryngoscope for airway management during general anesthesia: A systematic review and meta-analysis of randomized controlled trials

Maslanka

Smereka

Pruc³

et al. 2021

Disaster Emerg Med J

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INTRODUCTION:Despite the introduction of supraglottic devices for ventilation, endotracheal intubation is still a gold standard for airway management in both prehospital and operating theatre conditions. This systematic review and meta-analysis were conducted to investigate the effectiveness and safety of Airtraq vs. Macintosh laryngoscope for endotracheal intubation during general anesthesia. MATERIAL AND METHODS:The current issue of Pubmed, Embase, Cochrane, Web of science, Scopus (from database inception to October 20, 2020) was searched. Randomized controlled trials (RCT) comparing Airtraq and Macintosh laryngoscope were included in this meta-analysis. The primary outcomes were the success rate of first attempt intubation and intubation time. Secondary outcomes were overall intubation success rate, malposition, and adverse events. Review Manager 5.4 software was used to perform the pooled analysis and assess the risk of bias for each eligible RCT. RESULTS:Seventeen studies were included in the review for data extraction. First attempt success rate was 85.6% for ATQ vs. 68.4% for MAC (OR = 3.00; 95% CI: 1.37, 6.60; p = 0.006; I 2 = 63%). The use of ATQ and MAC for intubation in cervical spine immobilization was associated with the effectiveness of the first intubation attempt at 98.6% vs. 71.1% (OR = 16.40; 95% CI: 3.55, 78.87; p < 0.001; I 2 = 0%). Intubation time with ATQ was shorter than with MAC (MD = -3.19; 95% CI: -9.33, 2.95; p = 0.31; I 2 = 97%). The endotracheal intubation during cervical spinal intubation was associated with significantly shorter procedure duration for ATQ than for MAC (MD = -10.30; 95% CI: -18.43, -2.18; p = 0.01; I 2 = 74%). The total efficacy of intubation, which for ATQ and MAC varied and was 86.7% vs. 80.6% respectively (OR = 2.88; 95% CI: 1.61, 5.13; p < 0.001; I 2 = 0%). CONCLUSIONS:Based on the results of this analysis, we conclude that ATQ can reduce the failed first intubation attempt, especially in cervical manual inline stabilization patients, and reduces the time needed to obtain airway management, but does not provide significant benefits on other adverse events associated

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Video laryngoscopy for endotracheal intubation of adult patients with suspected/ confirmed COVID-19. A systematic review and meta-analysis of randomized controlled trials

Cited by 23 publications

References 0 publications

Impact of Coronavirus Disease 2019 on Out-of-Hospital Cardiac Arrest Survival Rate: A Systematic Review with Meta-Analysis

Impact of Coronavirus Disease 2019 on Out-of-Hospital Cardiac Arrest Survival Rate: A Systematic Review with Meta-Analysis

Comparison of different chest compression positions for use while wearing CBRN-PPE: a randomized crossover simulation trial

Airtraq® versus Macintosh laryngoscope for airway management during general anesthesia: A systematic review and meta-analysis of randomized controlled trials

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